A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,doub...A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.展开更多
AIM To assess the feasibility and parental acceptance of diagnostic microlaryngobronchoscopy(MLB) as day case surgery.METHODS A prospective study was performed over a 26 moperiod at a tertiary paediatric ENT centre. P...AIM To assess the feasibility and parental acceptance of diagnostic microlaryngobronchoscopy(MLB) as day case surgery.METHODS A prospective study was performed over a 26 moperiod at a tertiary paediatric ENT centre. Patients were selected in clinic using set criteria. All MLBs were performed using a standardised anaesthetic protocol and patients monitored post-operatively. Six weeks following surgery, parents underwent questionnaire surveys.RESULTS Ninety-four out of 101 MLBs was successfully performed as day case surgery over the set period. Seven patients required an overnight stay for further observation. Fiftyseven parents took part in the questionnaire of which 68.4% were highly satisfied with same day discharge. CONCLUSION MLB is feasible, safe and acceptable as day case surgery in carefully selected patients.展开更多
Many articles report that macrotia is a rare ear deformity, but this is not the reality that we encounter in our service. In accordance with anthropometric studies of the ears, we consider that an aesthetically normal...Many articles report that macrotia is a rare ear deformity, but this is not the reality that we encounter in our service. In accordance with anthropometric studies of the ears, we consider that an aesthetically normal ear measures 6.0 cm in length on the vertical axis and 3.7 cm on the horizontal axis in boys, with ear growth maturing at 13 years of age, and 5.91 cm in length on the vertical axis and 3.37 cm on the horizontal axis, with ear growth maturing at age 12 in girls. When the measurements exceed these averages, we consider that the patient has macrotia. The authors describe a new technique of surgical correction of macrotia that results in an average reduction of 1.7 cm on the vertical axis and 0.8 cm on the diagonal axis with an average surgical time of forty-five minutes, fast learning curve, and little scarring. This technique also allows it to be combined with otoplasty and correction of the lobe length. Because of these items we call the technique High-Performance Macrotia Surgery. Level IV: Evidence is obtained from multiple time series with or without the intervention, such as case studies.展开更多
Objective: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an out-patient regime, with safety, efficacy and short learning curve. Methods: We prospectively evaluated 1186 patients und...Objective: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an out-patient regime, with safety, efficacy and short learning curve. Methods: We prospectively evaluated 1186 patients undergoing inguinal hernia repair under local anesthesia on an outpatient basis between November 2004 and March 2014. Of the total number of hernias surgically treated in this period, 755 were operated on the right, 394 on the left and 37 bilateral. We used clinical, surgical and psychosocial criteria for inclusion in the procedure. The parameters for exclusion were complex, irreducible or recurrent hernia, obesity (BMI greater than 30 kg/m2), patient’s refusal and psychiatric disorder. All patients underwent elective surgery and were analyzed regarding surgical outcome, complications and hospital stay. Results: All operations were completed successfully. In no case there was a need to change the anesthetic method. Surgical time was similar to that conducted with other methods of anesthesia and there were no cases of adverse effects of local anesthetics. Intra-operative complications amounted to approximately 2.64%. There was no need for hospital admissions greater than 24 hours. Conclusion: The procedure is feasible and causes no perioperative significant pain, is safe, can be performed by residents under supervision, has satisfactory patient acceptance and complications similar to those observed in a conventional herniorrhaphy, allowing lower time and cost of hospitalization and faster access to treatment.展开更多
Office-based procedures can be a fulfilling part of the facial plastic practice with the right tools,personnel,and preparation.Equipping the clinic for office-based procedures has several unique considerations that ul...Office-based procedures can be a fulfilling part of the facial plastic practice with the right tools,personnel,and preparation.Equipping the clinic for office-based procedures has several unique considerations that ultimately impact its success.It is important to strategize preemptively regarding what treatments will be offered and the respective equipment that will allow the safe,cost-effective,and high-quality delivery of those treatments.Most procedures in the office-based setting are cosmetic in nature and there are often overlapping treatment modalities that target similar outcomes.Patient selection and counseling is a crucial step in preparing for office-based procedures in the effort to maximize patient satisfaction.Nearly all the most common facial plastic procedures can be delivered in the office-based based setting under local anesthesia and moderate sedation,depending on the expertise of the surgeon.To enable these and other categories of treatments,there are certain expensive pieces of technology that one might consider for their office-based practice and other fundamental supplies that are necessary for almost all practices.Though the initial investment in equipment can be costly,this article also discusses more affordable alternatives or third-party sales of devices and equipment.The field of facial plastic surgery is very dynamic and having both peer and mentorship networks is invaluable in navigating some of the financial decisions discussed herein.This article also briefly covers personnel,training,and accreditation considerations.展开更多
文摘A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.
文摘AIM To assess the feasibility and parental acceptance of diagnostic microlaryngobronchoscopy(MLB) as day case surgery.METHODS A prospective study was performed over a 26 moperiod at a tertiary paediatric ENT centre. Patients were selected in clinic using set criteria. All MLBs were performed using a standardised anaesthetic protocol and patients monitored post-operatively. Six weeks following surgery, parents underwent questionnaire surveys.RESULTS Ninety-four out of 101 MLBs was successfully performed as day case surgery over the set period. Seven patients required an overnight stay for further observation. Fiftyseven parents took part in the questionnaire of which 68.4% were highly satisfied with same day discharge. CONCLUSION MLB is feasible, safe and acceptable as day case surgery in carefully selected patients.
文摘Many articles report that macrotia is a rare ear deformity, but this is not the reality that we encounter in our service. In accordance with anthropometric studies of the ears, we consider that an aesthetically normal ear measures 6.0 cm in length on the vertical axis and 3.7 cm on the horizontal axis in boys, with ear growth maturing at 13 years of age, and 5.91 cm in length on the vertical axis and 3.37 cm on the horizontal axis, with ear growth maturing at age 12 in girls. When the measurements exceed these averages, we consider that the patient has macrotia. The authors describe a new technique of surgical correction of macrotia that results in an average reduction of 1.7 cm on the vertical axis and 0.8 cm on the diagonal axis with an average surgical time of forty-five minutes, fast learning curve, and little scarring. This technique also allows it to be combined with otoplasty and correction of the lobe length. Because of these items we call the technique High-Performance Macrotia Surgery. Level IV: Evidence is obtained from multiple time series with or without the intervention, such as case studies.
文摘Objective: To demonstrate the feasibility of inguinal hernia repair with local anesthesia in an out-patient regime, with safety, efficacy and short learning curve. Methods: We prospectively evaluated 1186 patients undergoing inguinal hernia repair under local anesthesia on an outpatient basis between November 2004 and March 2014. Of the total number of hernias surgically treated in this period, 755 were operated on the right, 394 on the left and 37 bilateral. We used clinical, surgical and psychosocial criteria for inclusion in the procedure. The parameters for exclusion were complex, irreducible or recurrent hernia, obesity (BMI greater than 30 kg/m2), patient’s refusal and psychiatric disorder. All patients underwent elective surgery and were analyzed regarding surgical outcome, complications and hospital stay. Results: All operations were completed successfully. In no case there was a need to change the anesthetic method. Surgical time was similar to that conducted with other methods of anesthesia and there were no cases of adverse effects of local anesthetics. Intra-operative complications amounted to approximately 2.64%. There was no need for hospital admissions greater than 24 hours. Conclusion: The procedure is feasible and causes no perioperative significant pain, is safe, can be performed by residents under supervision, has satisfactory patient acceptance and complications similar to those observed in a conventional herniorrhaphy, allowing lower time and cost of hospitalization and faster access to treatment.
文摘Office-based procedures can be a fulfilling part of the facial plastic practice with the right tools,personnel,and preparation.Equipping the clinic for office-based procedures has several unique considerations that ultimately impact its success.It is important to strategize preemptively regarding what treatments will be offered and the respective equipment that will allow the safe,cost-effective,and high-quality delivery of those treatments.Most procedures in the office-based setting are cosmetic in nature and there are often overlapping treatment modalities that target similar outcomes.Patient selection and counseling is a crucial step in preparing for office-based procedures in the effort to maximize patient satisfaction.Nearly all the most common facial plastic procedures can be delivered in the office-based based setting under local anesthesia and moderate sedation,depending on the expertise of the surgeon.To enable these and other categories of treatments,there are certain expensive pieces of technology that one might consider for their office-based practice and other fundamental supplies that are necessary for almost all practices.Though the initial investment in equipment can be costly,this article also discusses more affordable alternatives or third-party sales of devices and equipment.The field of facial plastic surgery is very dynamic and having both peer and mentorship networks is invaluable in navigating some of the financial decisions discussed herein.This article also briefly covers personnel,training,and accreditation considerations.
